Alkaline extracellular conditions promote the proliferation and mineralization of a human cementoblast cell line

AIM

To investigate the proliferation and mineralization of a human cementoblast cell line under alkaline conditions.

METHODOLOGY

A human cementoblast cell line was cultured in alkaline media with several pHs (pH 7.6, 8.0 and 8.4) without CO₂ . Cell numbers, phospho-p44/42 expression, alkaline phosphatase (ALP) activity and mineralization were evaluated. The significance of differences between groups was assessed using two-way analysis of variance 15 (ANOVA) followed by Bonferroni's multiple comparison test (α = 0.01).

RESULTS

Cell numbers increased in a time-dependent manner in the high pH medium groups. Western blot analysis revealed the upregulated expression of phospho-p44/42 under alkaline conditions. ALP activity was also increased at pH 8.0 and 8.4. Alizarin red staining revealed increased mineralization in the high pH medium groups. The incorporation of the transient receptor potential ankyrin subfamily member 1 (TRPA1) antagonist HC030031 markedly negated the effect on proliferation and mineralization.

CONCLUSIONS

Extracellular alkaline conditions promoted the proliferation and mineralization of human cementoblasts in vitro via TRPA1.

Prognostic value of quality-of-life scores in patients with breast cancer undergoing preoperative chemotherapy

Background

Recently, evaluation of quality of life (QOL) has been recognized as a significant outcome measure in the treatment of several cancers. In this study, the Anti-Cancer Drugs-Breast (ACD-B) QOL score was used to assess disease-specific survival in women with breast cancer undergoing preoperative chemotherapy (POC).

Methods

QOL-ACD-B scores were evaluated before and after POC. The cut-off value of QOL-ACD-B contributing to events such as relapse or death was calculated by receiver operating characteristic (ROC) curve analysis.

Results

In 300 women with breast cancer treated with POC, QOL was significantly reduced (P < 0·001). A high QOL-ACD-B score before POC was an independent factor in the multivariable analysis of overall survival (hazard ratio 0·26, 95 per cent c.i. 0·04 to 0·96).

Conclusion

Evaluation by QOL-ACD-B before POC may be useful to predict the prognosis of patients with breast cancer undergoing POC.

Abstract P6-09-25: Circulating tumor cell clusters-associated gene plakoglobin is a novel prognostic predictor in patients with breast cancer

Background: Accumulating evidence shows that circulating tumor cells (CTC) are linked to metastatic relapse and are regarded as a prognostic marker for human cancer. It was reported that CTC clusters (CTCc) have more metastatic potential than single CTC. Lately, studies also show that the high expression of plakoglobin, a cell adhesion protein, within the primary tumor are positively associated with CTCc in breast cancer patients. In addition, it is thought that insufficient expression of plakoglobin could promote epithelial-mesenchymal transition (EMT). In this study, we investigated the correlation between plakoglobin expression and survival of breast cancer.

Materials and Methods:A total of 126 patients with resectable early-stage breast cancer were treated with neoadjuvant chemotherapy (NAC). All patients received a standardized protocol of NAC consisting of four courses of FEC100 (500 mg/m2 fluorouracil, 100 mg/m2 epirubicin, and 500 mg/m2 cyclophosphamide) every 3 weeks, followed by 12 courses of 80 mg/m2 paclitaxel administered weekly. The expression of plakoglobin were identified by immunohistochemical staining properties in cell membrane. Staining with plakoglobin (clone 4C12) was scored according to the percentage of cells that stained positively: low, 0-25%; medium, 26-75%; high, &gt;75%. We investigated the correlation between the plakoglobin expression in primary tumor specimen and clinical outcomes including overall-survival (OS), disease-free-survival (DFS), distant-metastasis-free-survival (DMFS), the efficacy of NAC. And we examined the relation between the expression of plakoglobin and E-cadherin, EMT marker.

Results: The patient with high plakoglobin expression had significantly worse OS (p=0.021, log-rank) and DFS (p=0.015, log-rank), DMFS (p=0.040, log-rank). And the plakoglobin expression had no correlation with pathological complete response (pCR) rate (p=0.596). Also, there was not a statistically significant relationship between the plakoglobin expression and other clinicopathological parameters including tumor size (p=0.708), lymph node status (p=0.479), subtype (p=0.413), nuclear grade (p=0.642), Ki67 (p=0.202), tumor infiltrating lymphocytes (p=0.828). On univariate analysis with respect to distal metastasis, high plakoglobin expression showed worse prognosis than low plakoglobin expression (p=0.013, hazard ratio=4.221). And multivariate analysis found the same result (p=0.015, hazard ratio=4.070). In addition, there was a significant relationship between the expression of plakoglobin and E-cadherin (p=0.023).

Conclusions: Plakoglobin expression is an independent prognostic factor in the patients with breast cancer; particularly for DMFS, and this mechanism related to EMT.Background: Accumulating evidence shows that circulating tumor cells (CTC) are linked to metastatic relapse and are regarded as a prognostic marker for human cancer. It was reported that CTC clusters (CTCc) have more metastatic potential than single CTC. Lately, studies also show that the high expression of plakoglobin, a cell adhesion protein, within the primary tumor are positively associated with CTCc in breast cancer patients. In addition, it is thought that insufficient expression of plakoglobin could promote epithelial-mesenchymal transition (EMT). In this study, we investigated the correlation between plakoglobin expression and survival of breast cancer.

Materials and Methods:A total of 126 patients with resectable early-stage breast cancer were treated with neoadjuvant chemotherapy (NAC). All patients received a standardized protocol of NAC consisting of four courses of FEC100 (500 mg/m2 fluorouracil, 100 mg/m2 epirubicin, and 500 mg/m2 cyclophosphamide) every 3 weeks, followed by 12 courses of 80 mg/m2 paclitaxel administered weekly. The expression of plakoglobin were identified by immunohistochemical staining properties in cell membrane. Staining with plakoglobin (clone 4C12) was scored according to the percentage of cells that stained positively: low, 0-25%; medium, 26-75%; high, &gt;75%. We investigated the correlation between the plakoglobin expression in primary tumor specimen and clinical outcomes including overall-survival (OS), disease-free-survival (DFS), distant-metastasis-free-survival (DMFS), the efficacy of NAC. And we examined the relation between the expression of plakoglobin and E-cadherin, EMT marker.

Results: The patient with high plakoglobin expression had significantly worse OS (p=0.021, log-rank) and DFS (p=0.015, log-rank), DMFS (p=0.040, log-rank). And the plakoglobin expression had no correlation with pathological complete response (pCR) rate (p=0.596). Also, there was not a statistically significant relationship between the plakoglobin expression and other clinicopathological parameters including tumor size (p=0.708), lymph node status (p=0.479), subtype (p=0.413), nuclear grade (p=0.642), Ki67 (p=0.202), tumor infiltrating lymphocytes (p=0.828). On univariate analysis with respect to distal metastasis, high plakoglobin expression showed worse prognosis than low plakoglobin expression (p=0.013, hazard ratio=4.221). And multivariate analysis found the same result (p=0.015, hazard ratio=4.070). In addition, there was a significant relationship between the expression of plakoglobin and E-cadherin (p=0.023).

Conclusions: Plakoglobin expression is an independent prognostic factor in the patients with breast cancer; particularly for DMFS, and this mechanism related to EMT.

Citation Format: Goto W, Kashiwagi S, Asano Y, Takada K, Takashima T, Morisaki T, Noda S, Onoda N, Ohsawa M, Hirakawa K, Ohira M. Circulating tumor cell clusters-associated gene plakoglobin is a novel prognostic predictor in patients with breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-09-25.

Abstract P3-04-20: Predicting therapeutic effect by on tumor invasion lymphocytes (TILs) in endocrine therapy for stage IV breast cancer

Background: Breast cancer with distant metastasis at first presentation (stage IV disease) is often encountered in the outpatient department. With recent advances in multimodal therapies for breast cancer, long-term survival can now be expected even in stage IV breast cancer with distant metastasis. However, a goal in treating metastatic disease is prolongation of survival while maintaining good quality of life (QOL). Endocrine therapy is suitable for this purpose.The tumor immune environment not only modulates the effects of immunotherapy, but also the effects of other anticancer drugs and treatment outcomes. These immune responses can be evaluated with tumor-infiltrating lymphocytes (TILs), which has frequently been verified clinically. In the present study, we hypothesized that TILs would be useful as predictive marker of the therapeutic effect in endocrine therapy as well. In this study, the prediction of the therapeutic effect by TILs in endocrine therapy for stage IV breast cancer was clinically verified.

Materials and Methods:Data from 40 patients who underwent endocrine therapy as the initial drug therapy for stage IV breast cancer were used. The correlation between TILs evaluated according to the standard method, and prognosis, including the efficacy of endocrine therapy, was investigated retrospectively. Patients with 350% lymphocytic infiltration were considered to have lymphocyte-predominant breast cancer (LPBC).

Results:Among all 40 patients, TIL levels were high in 13 (32.5%) and low in 27 (67.5%) patients. Nine patients (22.5%) had LPBC, and 31 patients (77.5%) had non-LPBC. Investigation of the clinical pathological features of patients showed no significant differences between the high TIL and low TIL groups. There were also no significant differences between LPBC and non-LPBC patients. An analysis of outcomes comparing the high TIL and low TIL groups showed no prolongation in progression-free survival (PFS) (p=0.171, log-rank), time to treatment failure (TTF)(p=0.054), or overall survival (OS) (p=0.641). LPBC patients had significant prolongations of PFS (p=0.005), TTF (p=0.001), and OS (p=0.027) compared to non-LPBC patients. On receiver operating characteristic (ROC) curve analyses, results were better with LPBC (AUC: 0.700) than with TILs (AUC: 0.606).

Conclusion: The present findings suggest that a high level of lymphocytic infiltration in the tumor stroma may serve as a predictor of the therapeutic effect of endocrine therapy for patients with stage IV ER-positive breast cancer.

Citation Format: Kashiwagi S, Asano Y, Goto W, Takada K, Takashima T, Morisaki T, Noda S, Onoda N, Ohsawa M, Hirakawa K, Ohira M. Predicting therapeutic effect by on tumor invasion lymphocytes (TILs) in endocrine therapy for stage IV breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-04-20.

Abstract P2-05-05: Prediction of survival after neoadjuvant chemotherapy for breast cancer by evaluation of tumor-infiltrating lymphocytes (TILs) and residual cancer burden (RCB)

Background: The tumor immune environment not only modulates the effects of immunotherapy, but also the effects of other anticancer drugs and treatment outcomes. Thus, the importance of inhibiting and improving the tumor immune microenvironment is now recognized. These immune responses can be evaluated with tumor-infiltrating lymphocytes (TILs), which has frequently been verified clinically. On the other hand, residual cancer burden (RCB) evaluation has been shown to be a useful predictor of survival after neoadjuvant chemotherapy (NAC). In this study, RCB and TILs evaluations were combined to produce an indicator that we have termed “RCB-TILs”, and its clinical application to NAC for breast cancer was verified by subtype-stratified analysis.

Materials and Methods:A total of 177 patients with resectable early-stage breast cancer were treated with NAC.The correlation between TILs evaluated according to the standard method, and prognosis, including the efficacy of NAC, was investigated retrospectively. The RCB was calculated using the Residual Cancer Burden Calculator on the website of the MD Anderson Cancer Center. The RCB and TILs evaluations were combined to create the “RCB-TILs”. Patients who were RCB-positive and had high TILs were considered RCB-TILs-positive, and all other combinations were RCB-TILs-negative.

Results: Univariable analysis of patients with high TILs found that this contributed significantly to prolonging DFS in all patients (p = 0.022, hazard ratio = 0.420), TNBC patients (p = 0.004, hazard ratio = 0.177), and HER2BC patients (p = 0.026, hazard ratio = 0.123). For HRBC patients, however, high TILs did not contribute to survival (p = 0.990, hazard ratio = 0.992). Being RCB-TILs-positive, however, contributed significantly to prolonging DFS in all patients (p &lt; 0.001, hazard ratio = 0.181), TNBC patients (p &lt; 0.001, hazard ratio = 0.099), HER2BC patients (p = 0.026, hazard ratio = 0.123), and HRBC patients (p = 0.039, hazard ratio = 0.258). On multivariable analysis, being RCB-TILs-positive was an independent factor for recurrence after NAC in all patients (p &lt; 0.001, hazard ratio = 0.048), TNBC patients (p = 0.018, hazard ratio = 0.041), HER2BC patients (p = 0.036, hazard ratio = 0.134), and HRBC patients (p = 0.002, hazard ratio = 0.081).

Conclusion: The results of the present study suggest that RCB-TILs is a significant predictor for breast cancer recurrence after NAC and may be a more sensitive indicator than TILs alone.

Citation Format: Asano Y, Kashiwagi S, Goto W, Takada K, Takashima T, Morisaki T, Noda S, Onoda N, Ohsawa M, Hirakawa K, Ohira M. Prediction of survival after neoadjuvant chemotherapy for breast cancer by evaluation of tumor-infiltrating lymphocytes (TILs) and residual cancer burden (RCB) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-05-05.

Antiviral Effect of Interferon Therapy for Patients with Chronic Hepatitis C

Thirty-two patients with chronic hepatitis who were positive for hepatitis C virus (HCV) RNA by polymerase chain reaction and had antibody to HCV (anti-HCV), were enrolled in this study. Twenty of them were also positive for antibody to the GOR epitope (anti-GOR). Sixteen of the enrolled patients were treated with human lymphoblastoid interferon for six months. Treatment was initiated with 3 million units of interferon daily for 2 weeks, followed by 3 million units three times a week for 6 weeks and 1.5 million units three times a week for 16 weeks. The efficacy of therapy was assessed by comparison with the results in 16 untreated patients. Aminotransferase values, titre of anti-HCV and anti-GOR antibodies showed significant decreases throughout the therapy compared with baseline levels and the untreated patients. After a 3 month follow-up, nine treated patients (56.3%) had normal aminotransferase activities and six of them eliminated HCV RNA from their sera (37.5%). Three of these six patients became negative for both anti-HCV and anti-GOR antibodies (18.8%). None of the untreated control patients had normal aminotransferase activities or became negative for HCV markers. The present study suggests that human lymphoblastoid interferon can control the disease activity and eliminate hepatitis C virus from patients with chronic hepatitis C.

Tumour-infiltrating CD8 to FOXP3 lymphocyte ratio in predicting treatment responses to neoadjuvant chemotherapy of aggressive breast cancer

BACKGROUND

Tumour-infiltrating lymphocytes (TILs) can be used to monitor the immune response, and are important in predicting treatment responses and outcomes for various types of cancer. Recently, specific TIL subsets have been reported to be clinically useful in predicting treatment responses. The CD8+/FOXP3+ TIL ratio (CFR) may be a more sensitive indicator for monitoring immune function. This study investigated the clinical significance and value of CFR as a biomarker to predict treatment responses to neoadjuvant chemotherapy for breast cancer.

METHODS

Patients with resectable early-stage breast cancer treated with neoadjuvant chemotherapy at Osaka City University Hospital, Japan, between 2007 and 2013 were included. Oestrogen receptor, progesterone receptor, human epidermal growth factor receptor (HER) 2, Ki-67, CD8 and FOXP3 status were assessed by immunohistochemistry, and correlated with pathological complete response (pCR).

RESULTS

A total of 177 patients were included, of whom 90 had a high CFR and 87 a low CFR. Triple-negative breast cancer (TNBC) was more common in the high-CFR group than in the low-CFR group (46 versus 23 per cent; P = 0·002), as was HER2-enriched breast cancer (HER2BC) (27 versus 14 per cent; P = 0·033). Among these patients, the pCR rate was significantly higher in the high-CFR group than in the low-CFR group (TNBC: P = 0·022; HER2BC: P < 0·001). In multivariable analysis high-CFR status was an independent predictor of a favourable prognosis: hazard ratio 0·24 (95 per cent c.i. 0·05 to 0·72; P = 0·015) for TNBC and 0·10 (0·10 to 0·90; P = 0·041) for HER2BC.

CONCLUSION

The CFR may be a useful biomarker to predict treatment response to neoadjuvant therapy in aggressive breast cancer subtypes, such as TNBC and HER2BC.

Abstract P3-07-33: Prediction of the treatment response to neoadjuvant chemotherapy in breast cancer by subtypes using tumor-infiltrating lymphocytes

Purpose: Monitoring the host immunological response to cancer in the microenvironment of the interaction between tumor and the body plays an important role in predicting treatment response and outcomes. Recent interest has focused on the morphological evaluation of tumor-infiltrating lymphocytes (TILs) in breast cancer (BC) and on the evidence showing their clinical relevance. Meanwhile, no consensus has yet been reached on standard methods for pathological evaluation of TILs. Therefore, methods of evaluation have differed in reports to date showing the clinical relevance of TILs. An International Working Group (2014) announced recommendations for evaluating TILs in an effort to improve consistency and reproducibility. In this study, the clinical validity and utility of TILs in NAC were investigated based on this recommendation with a stratified analysis by BC subtypes. Changes in TILs after recurrence, which have seldom been reported to date, are also discussed.

Experimental Design: TILs was evaluated in 177 patients with breast cancer treated with NAC and subsequent curative surgery. All patients received a standardized protocol of NAC consisting of four courses of FEC100 (500 mg/m2 fluorouracil, 100 mg/m2 epirubicin, and 500 mg/m2 cyclophosphamide) every 3 weeks, followed by 12 courses of 80 mg/m2 paclitaxel administered weekly. Forty-five patients had HER2-positive breast cancer and were additionally administered weekly (2 mg/kg) or tri-weekly (6 mg/kg) trastuzumab during paclitaxel treatment. The correlation between TILs evaluated according to the standard method, and prognosis, including the efficacy of NAC, was investigated retrospectively.

Results: In the 96 high-TIL group, compared to the 81 low-TIL group, triple-negative breast cancer (TNBC) (p &lt; 0.001) and HER2-enriched (p = 0.040) were significantly more frequent, and the pathological complete response (pCR) rate were significantly higher (p = 0.003). On multivariate analysis also demonstrated that high-TIL status was an independent factor to indicate significantly more favorable prognosis of the patients compared with low-TIL status (p = 0.036, HR = 0.45). Among the 61 TNBC and the 36 HER2-enriched patients, the pCR rate was significantly higher in the high-TIL group than in the low-TIL group (p = 0.013) (p = 0.014). On multivariate analysis also showed that high-TIL status was an independent factor to predict the favorable prognosis (p = 0.023, HR = 0.24) (p = 0.036, HR = 0.13). Biopsy specimens from local recurrence after successful NAC frequently showed decreased TILs.

Conclusion: TILs may be a biomarker to predict treatment response to NAC in patients with TNBC and HER2-enriched subtypes of BC. A decrease in TILs may also be associated with tumor recurrence.

Citation Format: Kashiwagi S, Asano Y, Goto W, Morisaki T, Noda S, Takashima T, Onoda N, Hirakawa K. Prediction of the treatment response to neoadjuvant chemotherapy in breast cancer by subtypes using tumor-infiltrating lymphocytes. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-07-33.

Abstract P4-04-14: Prediction of treatment responses to neoadjuvant chemotherapy in triple-negative breast cancer by analysis of immune checkpoint protein expression

Purpose: "Avoiding immune destruction" has recently been established as one of the hallmarks of cancer. The programmed cell death (PD)-1/programmed cell death-ligand (PD-L) 1 pathway is also an important immunosuppression mechanism that allows cancer cells to escape host immunity. The effect of the tumor immune environment not only on immunotherapy effectiveness, but also on conventional anti-tumor therapy effectiveness and prognosis, has recently been demonstrated. Thus, improvement of the tumor immune environment is important. In other words, the tumor immune environment plays a role in the anti-tumor effects of conventional anti-tumor drugs. Moreover, immune checkpoint proteins such as PD-1, PD-L1, and PD-L2 may play an important role in improving the tumor immune environment. Given this background, the clinical significance of immune checkpoint protein expression was investigated in patients receiving neoadjuvant chemotherapy (NAC) for breast cancer using conventional anti-cancer drugs, and whether this would be useful as a marker to predict treatment response was evaluated.

Experimental Design: A total of 177 patients with resectable early-stage breast cancer were treated with NAC. All patients received a standardized protocol of NAC consisting of four courses of FEC100 (500 mg/m2 fluorouracil, 100 mg/m2 epirubicin, and 500 mg/m2 cyclophosphamide) every 3 weeks, followed by 12 courses of 80 mg/m2 paclitaxel administered weekly. Forty-five patients had HER2-positive breast cancer and were additionally administered weekly (2 mg/kg) or tri-weekly (6 mg/kg) trastuzumab during paclitaxel treatment. ER, PR, HER2, Ki67, PD-L1, PDL-2 and PD-1 status were assessed by immunohistochemistry on core needle biopsy specimens.

Results: There were 37 (20.9%) patients with high PD-1 expression, 42 (23.7%) patients had high PD-L1 expression, and 52 (29.4%) patients had high PD-L2 expression. The patients with high PD-1 and PD-L1 expressions had a significantly higher rate of triple-negative breast cancer (TNBC) (p=0.041) (p&lt;0.001). Univariate analysis showed that PD-1 and PD-L1 expressions were associated with significantly shorter DFS (p=0.008, HR=2.752) (p=0.002, HR=3.194). However, although multivariate analysis showed that lymph node metastases were an independent poor prognostic factor (p=0.046, HR=4.330), PD-1 and PD-L1 expressions were not independent prognostic factors (p=0.492, HR=1.415) (p=0.084, HR=2.613). In TNBC, patients with high PD-1 and PD-L1 expressions had significantly higher rates of non-pCR (p=0.003) (p&lt;0.001). Univariate analysis showed that PD-1 and PD-L1 expressions also significantly shortened disease free survival in TNBC (p=0.048, HR=3.318) (p=0.007, HR=8.375). However, multivariate analysis found that only PD-L1 expression was an independent prognostic factor (p=0.041, HR=9.479).

Conclusions: PD-1 and PD-L1 expressions may be useful as biomarkers to predict treatment responses to NAC in breast cancer. Above all, PD-L1 expression may also be useful as biomarkers for more effective chemotherapy in TNBC.

Citation Format: Asano Y, Kashiwagi S, Goto W, Morisaki T, Noda S, Takashima T, Onoda N, Hirakawa K. Prediction of treatment responses to neoadjuvant chemotherapy in triple-negative breast cancer by analysis of immune checkpoint protein expression. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-04-14.

Alginate encapsulant incorporating CXCL12 supports long-term allo- and xenoislet transplantation without systemic immune suppression

Islet transplantation represents a potentially curative approach for individuals with Type I Diabetes. The requirement for systemic immune suppression to control immune-mediated rejection of transplanted islets and the limited human islet supply represent significant roadblocks to progress for this approach. Islet microencapsulation in alginate offers limited protection in the absence of systemic immunosuppression, but does not support long-term islet survival. The chemokine, CXCL12, can repel effector T cells while recruiting immune-suppressive regulatory T cells (Tregs) to an anatomic site while providing a prosurvival signal for beta-cells. We proposed that coating or encapsulating donor islets with CXCL12 would induce local immune-isolation and protect and support the function of an allo- or xenograft without systemic immune suppression. This study investigated the effect of alginate microcapsules incorporating CXCL12 on islet function. Islet transplantation was performed in murine models of insulin-dependent diabetes. Coating of islets with CXCL12 or microencapsulation of islets with alginate incorporating the chemokine, resulted in long-term allo- and xenoislet survival and function, as well as a selective increase in intragraft Tregs. These data support the use of CXCL12 as a coating or a component of an alginate encapsulant to induce sustained local immune-isolation for allo- or xenoislet transplantation without systemic immunosuppression.

c-Kit expression as a prognostic molecular marker in patients with basal-like breast cancer

Background

As patients with basal-like breast cancer (BLBC) have a poor prognosis and there is no specifically tailored therapy, molecular biological characterization of BLBC is necessary. c-Kit is a transmembrane receptor tyrosine kinase known to play important roles in various solid cancers. This study classified BLBCs from patients with breast carcinoma, and addressed the significance of c-Kit expression in these tumours.

Methods

Primary breast tumours were stained with antibodies against oestrogen receptor, progesterone receptor, human epidermal growth factor receptor (HER) 2, epidermal growth factor receptor (EGFR), cytokeratin 5/6 and c-Kit. The association between c-Kit, BLBC and survival was analysed.

Results

A total of 667 patients with breast cancer were followed up for a median of 39 (range 6–72) months. Some 190 tumours (28·5 per cent) were classified as triple-negative for breast cancer (negative for oestrogen receptor, progesterone receptor and HER2) and 149 (78·4 per cent) had characteristics of BLBC (positive for cytokeratin 5/6 and/or EGFR). c-Kit expression was detected in 111 (16·6 per cent) of 667 tumours. c-Kit-positive tumours were more commonly found among patients with BLBC (42 of 149, 28·2 per cent; P &lt; 0·001) and in patients with nodal metastasis (47 of 216, 21·8 per cent; P = 0·014) than in those without. In patients with BLBC, the prognosis was significantly worse in those with c-Kit expression (P &lt; 0·001). Multivariable logistic regression analysis revealed c-Kit as an independent negative prognostic factor for cancer-specific survival in patients with BLBC (hazard ratio 2·29, 95 per cent confidence interval 1·11 to 4·72).

Conclusion

c-Kit might be a prognostic marker and possible molecular target for therapy in patients with BLBC.

Upregulation of cancer-associated myofibroblasts by TGF-β from scirrhous gastric carcinoma cells

BACKGROUND

Myofibroblasts in the cancer microenvironment have recently been implicated in tumour growth and metastasis of gastric cancer. However, the mechanisms responsible for the regulation of myofibroblasts in cancer-associated fibroblasts (CAFs) remain unclear. This study was performed to clarify the mechanisms for regulation of myofibroblasts in gastric cancer microenvironment.

METHODS

Two CAFs (CaF-29 and CaF-33) from the tumoural gastric wall and a normal fibroblast (NF-29) from the nontumoural gastric wall, 4 human gastric cancer cell lines from scirrhous gastric cancer (OCUM-2MD3 and OCUM-12), and non-scirrhous gastric cancer (MKN-45 and MKN-74) were used. Immunofluorescence microscopy by triple-immunofluorescence labelling (α-SMA, vimentin, and DAPI) was performed to determine the presence of α-SMA-positive myofibroblasts. Real-time RT-PCR was performed to examine α-SMA mRNA expression.

RESULTS

Immunofluorescence microscopy showed that the frequency of myofibroblasts in CaF-29 was greater than that in NF-29. The number of myofibroblasts in gastric fibroblasts gradually decreased with serial passages. Transforming growth factor-β (TGF-β) significantly increased the α-SMA expression level of CAFs. Conditioned medium from OCUM-2MD3 or OCUM-12 cells upregulated the α-SMA expression level of CAFs, but that from MKN-45 or MKN-74 cells did not. The α-SMA upregulation effect of conditioned medium from OCUM-2MD3 or OCUM-12 cells was significantly decreased by an anti-TGF-β antibody or Smad2 siRNA.

CONCLUSION

Transforming growth factor-β from scirrhous gastric carcinoma cells upregulates the number of myofibroblasts in CAFs.

The free-radical scavenger, edaravone, augments NO release from vascular cells and platelets after laser-induced, acute endothelial injury in vivo

In vitro and in vivo experimental models have demonstrated that vascular endothelial function is significantly impaired as a result of oxidative stress, mediated by the generation of oxygen-derived free radicals in response to chronic or acute inflammation. In particular, super-oxide () at specific concentrations leads to the impairment of nitric oxide (NO) bioactivity, and it is known that NO plays a fundamental role in the maintenance of vascular homeostasis. The relationship between reactive oxygen species (ROS) and NO release in thrombosis-related endothelial damage in the peripheral microvasculature remains unclear, however. The purpose of the present study was to investigate the effect of the free-radical scavenger, edaravone, on NO synthesis and thrombotic potential in arterioles after exposure to laser irradiation. Highly sensitive electrochemical NO microsensors were positioned in femoral arterioles of mice, and the kinetics of NO release were recorded in response to standardized laser irradiation in vivo. In addition, images of NO release from damaged vascular cells were investigated in a similar rat model using the NO-sensitive dye 4,5-diaminofluorescein diacetate (DAF-2DA). Thrombogenesis was assessed in carotid arterioles by continuous video microscopy using image analysis software. Laser irradiation led to NO release from perturbed endothelial cells and from platelet-rich thrombi. Edaravone had no significant effect on NO release in non-laser treated, intact endothelium compared with placebo. In contrast, edaravone demonstrated a dose-dependent effect on NO release and thrombogenicity. At a concentration of 10.5 mg/kg per h, edaravone promoted a 5-fold increase in NO and a reduction in platelet-rich thrombus volume to 58% of the placebo values. Our data provide direct evidence to confirm that acute endothelial damage in peripheral microvessels initially induces NO release and that the free-radical scavenger, edaravone, augments NO synthesis leading to suppression of platelet thrombus formation.

Dynamic behavior of individual cells in developing organotypic brain slices revealed by the photoconvertable protein Kaede

In recent years, advances in optical imaging methods have facilitated the visualization of events in the developing cortex. In particular, the introduction of DNA encoding fluorescent protein into cells of the embryonic brain allows the visualization of progenitor cells; slice preparations of the cortex then allow the monitoring of the behavior of transfected cells in the context of the living cerebral wall by time-lapse microscopy. Such approaches have provided substantial information about the patterns of neuronal migration. However, as these techniques label large numbers of cells in the ventricular zone (VZ), it is difficult to follow individual cell shape changes or cell behaviors within the VZ, where neuron production and initial migration take place. Here, we report a unique method using the photoconvertable fluorescent protein Kaede, which emits green fluorescence and shifts to emitting red fluorescence upon radiation with UV. Using this method, we were able to follow the behavior of a particular pair of daughter cells among neighboring Kaede-positive cells in the SVZ of mouse brain slices. The spindle shape progenitor divided into two multipolar-shaped daughter cells. The cell-cell borders of daughter cells were clearly visualized, and easily describe the position and distance between two or more cells. The photoconvertable property of Kaede offers a powerful cell marking tool to identify the precise morphology and migratory behaviors of individual cells within living cortical slices.

Construction of a self-cloning sake yeast that overexpresses alcohol acetyltransferase gene by a two-step gene replacement protocol

The commercial application of genetically modified industrial microorganisms has been problematic due to public concerns. We constructed a "self-cloning" sake yeast strain that overexpresses the ATF1 gene encoding alcohol acetyltransferase, to improve the flavor profile of Japanese sake. A constitutive yeast overexpression promoter, TDH3p, derived from the glyceraldehyde-3-phosphate dehydrogenase gene from sake yeast was fused to ATF1; and the 5' upstream non-coding sequence of ATF1 was further fused to TDH3p-ATF1. The fragment was placed on a binary vector, pGG119, containing a drug-resistance marker for transformation and a counter-selection marker for excision of unwanted DNA. The plasmid was integrated into the ATF1 locus of a sake yeast strain. This integration constructed tandem repeats of ATF1 and TDH3p-ATF1 sequences, between which the plasmid was inserted. Loss of the plasmid, which occurs through homologous recombination between either the TDH3p downstream ATF1 repeats or the TDH3p upstream repeat sequences, was selected by growing transformants on counter-selective medium. Recombination between the downstream repeats led to reversion to a wild type strain, but that between the upstream repeats resulted in a strain that possessed TDH3p-ATF1 without the extraneous DNA sequences. The self-cloning TDH3p-ATF1 yeast strain produced a higher amount of isoamyl acetate. This is the first expression-controlled self-cloning industrial yeast.

Age-related accumulation of Ig V(H) gene somatic mutations in peripheral B cells from aged humans

To investigate age-related alterations in human humoral immunity, we analysed Ig heavy chain variable region genes expressed by peripheral B cells from young and aged individuals. Three hundred and twenty-seven cDNA sequences, 163 micro and 164 gamma transcripts with VH5 family genes, were analysed for somatic hypermutation and VHDJH recombinational features. Unmutated and mutated micro transcripts were interpreted as being from naive and memory IgM B cells, respectively. In young and aged individuals, the percentages of naive IgM among total micro transcripts were 39% and 42%, respectively. D and JH segment usage in naive IgM from aged individuals was similar to that from young individuals. The mutational frequencies of memory IgM were similar in young and aged individuals. gamma transcripts, which are regarded as being from memory IgG B cells, showed a significantly higher mutational frequency (7.6%) in aged than in young individuals (5.8%) (P < 0.01). These findings suggest that VHDJH recombinational diversity was preserved, but that the accumulation of somatic mutations in the IgG VH region was increased in aged humans. The accumulation of somatic mutations in IgG B cells during ageing may imply that an age-related alteration exists in the selection and/or maintenance of peripheral memory B cells.

Extremely low vertical-emittance beam in the accelerator test facility at KEK

Electron beams with the lowest, normalized transverse emittance recorded so far were produced and confirmed in single-bunch-mode operation of the Accelerator Test Facility at KEK. We established a tuning method of the damping ring which achieves a small vertical dispersion and small x-y orbit coupling. The vertical emittance was less than 1% of the horizontal emittance. At the zero-intensity limit, the vertical normalized emittance was less than 2.8 x 10(-8) rad m at beam energy 1.3 GeV. At high intensity, strong effects of intrabeam scattering were observed, which had been expected in view of the extremely high particle density due to the small transverse emittance.

A reduction in the number of peripheral CD28+CD8+T cells in the acute phase of influenza

Influenza patients show a high incidence of T lymphocytopenia in the acute phase of the illness. Since CD8+ T cells play an important role in influenza virus infection, we investigated which subset of CD8+ T cells was involved in this lymphocytopenia. CD8+ T cells from eight patients with influenza A were studied for lymphocyte count, surface marker, and intracellular IFN-gamma production in the acute (days 1-3) and recovery phases (days 9-12). Total and T lymphocyte counts in the acute phase were approximately three times less than in the recovery phase; however, the CD4/8 ratio was the same in both phases. The cell count reduction in the acute phase was attributed predominantly to the CD28+ CD8+ subset, compared with the CD28- CD8+ subset. The memory/activation marker CD45RO on the CD8+ T cells was assessed. The CD28+ CD45RO- subset, a naive phenotype, was reduced significantly in number in the acute phase compared with the recovery phase. The CD28+ CD45RO+ subset, a memory phenotype, was also reduced in the acute phase, but the reduction was not statistically significant. Intracellular IFN-gamma in the CD8+ subset after mitogenic stimulation was measured by flow cytometry; the percentage of CD28+ IFN-gamma-/CD8+ subset in the acute phase was significantly less than in the recovery phase. These results indicated that the predominant reduction of peripheral CD8+ T cells in the acute phase of influenza was from naive-type lymphocytes, suggesting that these quantitative and qualitative changes of CD8+ T cells in influenza are important for understanding the immunological pathogenesis.

The effectiveness of anti-retroviral drug therapy for HIV-1 is associated with HIV-1 proviral DNA levels and viral selection

The effect of combination anti-retroviral therapy regimens on HIV-1 proviral DNA levels in peripheral blood mononuclear cells was examined in 12 HIV-1-positive patients, using endpoint dilution polymerase chain reaction and serial cloning, and sequencing of the gag region of HIV-1. The major clone was defined as the most numerous of 10 analysed clones, and observation periods ranged from 8 months to 32 months (mean 19.7 +/- 10.2 months). In five patients (one with primary-stage HIV-1 infection) receiving three anti-retroviral drugs, HIV-1 RNA reduced to undetectable levels (i.e. < or = 100 copies/ml). HIV-1 proviral DNA and the number of major clones reduced in four of these patients. HIV-1 RNA levels reduced, but remained detectable, in five other patients. In the two remaining patients (both receiving two rather than three anti-retroviral drugs), HIV-1 RNA levels increased. These results suggest that the population of major clones may be affected when HIV-1 RNA levels reduce following combination regimens of anti-retroviral therapy.

Human T lymphotropic virus type 1 infection influences hepatitis C virus clearance

To explore the effect of human T lymphotropic virus type 1 (HTLV-1) infection on hepatitis C virus (HCV) infection, a survey for these viral infections was conducted that involved 2280 residents in an area in which HTLV-1 and HCV are endemic. The response of patients with HCV and HTLV-1 to interferon (IFN)-alpha treatment was also assessed. Antibody to HCV was detected in 13.8% of the residents tested, and antibody to HTLV-1 was detected in 15.4%. The prevalence of HCV RNA was significantly higher among residents who had antibodies to both HCV and HTLV-1 than in those who had antibodies to HCV only (P<.05). Sustained elimination of HCV RNA by IFN was significantly more frequent among patients with HCV alone than among those with HCV and HTLV-1. By logistic regression analysis, HTLV-1 infection was associated with nonresponse to IFN treatment. Thus, HTLV-1 infection affects the clearance, both natural and in association with IFN treatment, of HCV.

Evidence of B cell clonal expansion in HIV type 1-infected patients

HIV-1 infection results in a gradual decrease in CD4(+) T cell counts and progressive immune deficiency. Increased T cell turnover in HIV-1-infected patients, which can be interpreted as T cell clonal expansion, has been thought to be relevant to its pathogenesis. To investigate whether B cell clonal expansion also occurs in HIV-1-infected patients, we examined the expressed V(H)DJ(H) gene sequences of peripheral B cells in HIV-1-infected patients with hypergammaglobulinemia. Identical V(H)DJ(H) gene rearrangements with additional nucleotide differences in V(H) genes were analyzed as a marker of clonally related B cells. From healthy individuals and HIV-1-uninfected patients with hypergammaglobulinemia, clonally related B cells were detected in none of 10 (0%) and 2 of 10 (20%), respectively. No clonally related B cells were detected in any of the nine HIV-1-infected patients with detectable viral loads and normal Ig levels (0%). In contrast, from 9 of 14 HIV-1-infected patients with hypergammaglobulinemia (64%), clonally related B cells were detected. In addition, no HIV-1-infected patients who exhibited normal Ig levels after antiretroviral therapy had clonally related B cells. These findings suggest that B cell clonal expansion is present in HIV-1-infected patients with hypergammaglobulinemia.

[A case of severe adult measles pneumonia--efficacy of combination of steroid pulse therapy, high-dose vitamin A and gamma globulins]

A 33 year-old female was admitted with facial, trunk and limb eruptions, conjunctiva intrahemorrhage, Koplik's spots in the pharynx and severe hypoxemia after fever and upper respiratory tract symptom. Infiltrative shadow of the whole right lung was seen on chest radiography. Fine crackles were seen in the lower left lung and in the whole right lung. Severe inflammation and liver dysfunction were indicated by blood test. Measles antibody IgM was high. The abnormal interstitial shadows were confirmed in greater detail by chest computed tomography. Her condition was diagnosed as measles pneumonia. A combination therapy with steroid pulse, high dose vitamin A, and gamma globulin was started, after which the patient gradually improved, indicating the effectiveness of this combination therapy for severe adult measles pneumonia.

Hepatitis B virus genomes of chronic hepatitis patients do not contain specific mutations related to acute exacerbation

To determine the specific viral variants associated with acute exacerbation of chronic hepatitis from hepatitis B virus (HBV) infection, we analyzed the complete nucleotide sequences of the HBV genome in serial serum samples from two chronic active hepatitis patients who seroconverted from HBeAg to anti-HBe. HBV DNA was amplified by polymerase chain reaction (PCR) and sequenced. A 1896 precore stop codon mutant (G to A at nt 1896) coexisting with the wild sequence was found in both patients prior to seroconversion from HBeAg to anti-HBe. Core promoter mutations at nucleotide positions 1762 (A to T) and 1764 (G to A) were found in both patients throughout the observation period. Mutations were observed in the HBV genome of the two patients at different time points, and there was no correlation between the mutations and liver disease or DNA polymerase levels. The nucleotide divergence rate and the composition of quasispecies in the HBV sequence at the time of acute exacerbation were almost the same as were found at other time points. These results suggest that acute exacerbation does not appear to be caused by a characteristic HBV species. The multiple factors that cause generalized HBV replication activation may contribute to acute exacerbation.

[Effect of highly active antiretroviral therapy (HAART) on hypergammaglobulinemia in HIV infected patients]

To investigate the mechanism of hypergammaglobulinemia in HIV infected patients, the effect of highly active antiretroviral therapy (HAART) on the hypergammaglobulinemia was analyzed. Involved in this study were 34 untreated, 21 HAART-effective (complete response) and 14 HAART-non-effective (partial response) patients. Serum levels of HIV-RNA and gammaglobulin and immunoglobulin (Ig) isotypes were measured. Mean HIV-RNA levels of untreated and partial response patients were 1.6 x 10(4) copies/ml and 0.4 x 10(4) copies/ml, respectively. HIV-RNA levels of all complete response patients were below 4.0 x 10(2) copies/ml. Mean gammaglobulin percentages of untreated, partial response and complete response patients were 24.4%, 21.8% and 17.9%, respectively (p < 0.01 in untreated vs complete response patients). Mean IgG levels in the three groups were 2,489 mg/dl, 1,947 mg/dl and 1,618 mg/dl, respectively (p < 0.001 in untreated vs complete response patients). IgA levels were high in some untreated patients and lower in complete response patients. IgE levels were increased in some untreated and partial response patients, but there was no significant difference among the three groups. These results suggested that the hypergammaglobulinemia found in HIV infected patients was associated with HIV replication. The activation mechanism might differ by Ig isotypes.

Acute hepatitis C among Japanese hemodialysis patients: a prospective 9-year study

OBJECTIVES

The aims of this prospective survey were to determine the incidence and clinical characteristics of newly acquired hepatitis C virus (HCV) infection in hemodialysis patients after the start of antibody to HCV (anti-HCV) screening for blood products in Japan in 1989.

METHODS

In serial serum samples from 269 hemodialysis patients who were followed over a mean period of 6.6 yr (+/- 2.1 yr) from 1990 to 1998, HCV RNA and anti-HCV were detected by reverse transcription-polymerase chain reaction and second generation ELISA, respectively.

RESULTS

During the observation period, newly acquired HCV infection was found in 26 (15.4%) of the 169 hemodialysis patients without anti-HCV or HCV RNA at entry, an annual incidence rate of 2.59%. Of these 26, only four had a history of blood transfusion, one of whom had received the blood transfusion after 1992, the year in which screening of blood products for anti-HCV by second-generation ELISA was introduced in Japan. Persistent HCV viremia was found in 17 (65.4%) of the 26 patients; the other nine (34.6%) had transient HCV infection. The mean period of continuous ALT abnormality was significantly longer in the former (12.4+/-13.6 months) than in the latter (1.9+/-3.5 months) (p = 0.0067). However, only three (17.6%) of 17 patients with chronic HCV viremia had continuous ALT abnormality for more than 24 months; in all of them, ALT eventually normalized.

CONCLUSIONS

These findings indicate that newly acquired HCV infection has continued to occur in hemodialysis patients after the initiation of anti-HCV screening of blood products and that the abnormal ALT found in these patients is related to HCV chronicity.